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Billing code 54401: Penile prosthesisMedicare rate & RVUs

Reports operative placement of a self-contained inflatable penile prosthesis, typically for erectile dysfunction when a patient chooses surgical treatment.

CMS RVU26DEffective Oct 1, 2026109 payment localities43 Medicare services in 2024

Medicare pays $617.58 for 54401 nationally in a facility.

Medicare rate · 54401

Penile prosthesis

Swap in your local Medicare rate.

Work RVUs
10.18
Total RVUs
18.49
Global days
090

National rate · 2026

$617.58

Facility setting, before claim adjustments.

See every locality for 54401 → · Billed by an NP, PA or therapist? →

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

On this page 10 sections
  1. Medicare rate
  2. What 54401 covers
  3. By payment locality
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Similar codes
  8. Related codes
  9. Billing questions
  10. Sources

What 54401 covers

A urologist places an inflatable penile implant whose inflation mechanism is self-contained, rather than using a separate pump and reservoir. The procedure is generally performed in an operating room for erectile dysfunction when the patient and surgeon select an implant after considering other treatment options. The device type distinguishes this service from placement of a semi-rigid implant or a multi-component inflatable system.

Report 54401 for initial implantation of the self-contained inflatable device, and document the indication, device type, and operative placement. Medicare assigns major-surgery global status: the day-before preoperative visit and 90 days of related postoperative care are included. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 is inappropriate for this descriptor and anatomy. Medicare does not pay an assistant at surgery under the stated statutory restriction; co-surgeon payment requires supporting documentation, and team surgery is not permitted.

This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.

Where 54401 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

54401 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$569.37
Alaska*Unavailable$783.14
ArizonaUnavailable$604.03
ArkansasUnavailable$563.39
AtlantaUnavailable$631.14
AustinUnavailable$626.84
BakersfieldUnavailable$629.38
Baltimore/Surr. CntysUnavailable$650.46
BeaumontUnavailable$593.43
BrazoriaUnavailable$608.57

54401 rates by state

Office rate range in each state. Select a state to see its payment localities.

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

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Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

View every state and territory as a table
54401 office rate range by state
State / territoryOffice rate rangeLocalities
AKNo published base rate1
ALNo published base rate1
ARNo published base rate1
AZNo published base rate1
CANo published base rate29
CONo published base rate1
CTNo published base rate1
DCNo published base rate1
DENo published base rate1
FLNo published base rate3
GANo published base rate2
GUNo published base rate1
HINo published base rate1
IANo published base rate1
IDNo published base rate1
ILNo published base rate4
INNo published base rate1
KSNo published base rate1
KYNo published base rate1
LANo published base rate2
MANo published base rate2
MDNo published base rate3
MENo published base rate2
MINo published base rate2
MNNo published base rate1
MONo published base rate3
MSNo published base rate1
MTNo published base rate1
NCNo published base rate1
NDNo published base rate1
NENo published base rate1
NHNo published base rate1
NJNo published base rate2
NMNo published base rate1
NVNo published base rate1
NYNo published base rate5
OHNo published base rate1
OKNo published base rate1
ORNo published base rate2
PANo published base rate2
PRNo published base rate1
RINo published base rate1
SCNo published base rate1
SDNo published base rate1
TNNo published base rate1
TXNo published base rate8
UTNo published base rate1
VANo published base rate2
VINo published base rate1
VTNo published base rate1
WANo published base rate2
WINo published base rate1
WVNo published base rate1
WYNo published base rate1

How the 54401 rate is calculated

Each of 54401’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.

How the rate is built · 54401

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 10.18Practice expense 7.00Malpractice 1.31

18.4900 adjusted RVUs×$33.4009 conversion factor=$617.58

All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.

Payment rules and modifiers for 54401

54401 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 54401

Penile prosthesis

RuleCMS valueWhat it means
Global period090Major surgery: the day before, the day of, and 90 days after are included.
Multiple procedures2Standard reduction: highest-valued procedure at 100%, others at 50%.
Bilateral (modifier 50)0The 150% bilateral adjustment doesn’t apply.
Assistant at surgery (80/81/82/AS)1Not paid (statutory restriction).
Co-surgeons (62)1Permitted with supporting documentation.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.
Split (54/55/56)0.10/0.80/0.10Share of the payment for pre-op, the procedure itself, and post-op care.

Global surgery period · 54401

Penile prosthesis

90-day global period ends

Dec 30, 2026

Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).

Visit on Oct 31, 2026

Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.

  • 24 Unrelated E/M visit by the same physician
  • 79 Unrelated procedure (starts its own global period)
  • 58 Staged, more extensive, or therapy procedure that was planned
  • 78 Unplanned return to the operating room for a related complication
SurgeryVisit
Sep 23, 2026Jan 10, 2027

Pre-op dayGlobal period

What modifiers do to the payment

Modifier 51 · payment effect

With and without the modifier

54401 without 51 · national facility

$617.58

Penile prosthesis

54401-51 · Second procedure: 50%

$308.79

When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).

When to use modifier 51

54401 compared with similar codes

Compare codes

54401 vs 54400 vs 54405 vs 54416 vs 54415: national Medicare rates

Swap in your local Medicare rate.

  • 54401
    Penile prosthesis · 10.18 wRVU
    —
  • 54400
    Penile prosthesis · 8.94 wRVU
    —
  • 54405
    Penile prosthesis · 14.16 wRVU
    —
  • 54416
    Penile prosthesis · 11.78 wRVU
    —
  • 54415
    Prosthesis removal · 8.66 wRVU
    —

How to choose

54400Penile prosthesis
Choose 54400 for a semi-rigid implant that does not inflate; 54401 is for an inflatable self-contained device.
54405Penile prosthesis
Choose 54405 when the inflatable implant is multi-component. The self-contained inflation mechanism identifies 54401.
54416Penile prosthesis
54416 describes removal and replacement of an existing self-contained or semi-rigid prosthesis; 54401 is for implantation, not an exchange.
54415Prosthesis removal
54415 is for removing a prosthesis without replacement. Report 54401 for initial placement of the self-contained inflatable device.

Codes related to 54401

Related codes aren’t interchangeable: bill the code that matches the service performed.

Codes related to 54401
CodeHow it relatesNational office range
Same family
54400Penile prosthesisInitial implantation of a semi-rigid, non-inflatable penile prosthesis.No office rate
54405Penile prosthesisInitial implantation of an inflatable multi-component penile prosthesis.No office rate
54415Prosthesis removalRemoval without replacement of a penile prosthesis in this device group.No office rate
54416Penile prosthesisRemoval and replacement of a self-contained or semi-rigid penile prosthesis.No office rate

54401 billing questions

How does 54401 differ from 54400?

54401 is for an inflatable, self-contained prosthesis. 54400 is for a non-inflatable, semi-rigid prosthesis.

When should 54405 be reported instead?

Use 54405 for an inflatable multi-component prosthesis, which has separate system components rather than a self-contained inflation mechanism.

Can modifier 50 be appended?

No. Modifier 50 is inappropriate for this descriptor and anatomy.

What postoperative care is included in the global period?

The day-before preoperative visit and 90 days of related postoperative care are included in the major-surgery global period.

How is 54401 handled when other procedures occur in the same session?

The highest-valued procedure is paid in full, and other procedures are subject to the standard multiple procedure reduction. Medicare does not pay an assistant at surgery; co-surgeon payment requires supporting documentation.

Where these rates come from

FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.

CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027

Show the CMS file lines behind this rate
RVUs for 54401PPRRVU2026_Oct_nonQPP.csv, line 6,293 (RVU26D)

Open CMS sourceHow we calculate rates

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